Ever been to a conjoined twin delivery?

nicudaynurse · Mar 5, 2003

Can't say I have ever seen conjoined twins. I would assume that there would be a team for each baby.

I don't have cable so I don't have TLC. I would love to have it though because of the medical shows, especially Labor and Delivery.

Conjoined twins are pretty rare, but it does happen.

dawngloves, BSN, RN · Mar 6, 2003

But in this case the twins shared a heart. Now would you treat them as a whole? I have heard of onther conjoined twins that share vital organs and wouldered how they were cared for.

NiteNICUNurse, BSN, RN · Mar 6, 2003

We had some conjoined twins a few months ago that were joined at the chest and shared a heart. There were 2 teams at the delivery (imagine trying to intubate 2 babies that face each other!) They were treated as seperate babies, which always seemed strange to me since they shared a circulatory system...meds, IVF etc. were divided in half. Different monitors, vents, etc. They were with us for a couple of months mom even breastfed at some point! Unfortunatly one heart couldnt sustain both of them and they went into CHF. They were so cute togther though they would "swat" each other and attmept to extubate the other one! Once extubated they would suck on each others hands. VERY CUTE!

dawngloves, BSN, RN · Mar 6, 2003

Originally posted by NiteNICUNurse
They were treated as seperate babies, which always seemed strange to me since they shared a circulatory system...meds, IVF etc. were divided in half.

This is exactly what I wonder about! How could you treat them seperately without considering the other. I'd really like to see that! (but not really, YKWIM?)

They sound like sweeties. So sad. It would break my heart.

nicudaynurse · Mar 7, 2003

NiteNICUNurse,

Sounds like you have had some interesting babies come through your unit. How big is your unit? Do you transport any babies to other facilities or do you handle them all?

pappyRN · Mar 7, 2003

Hi Dawngloves et all,

I've taken care of one set of conjoined twins and then cared for each individually after separation. It was quite an experience. They were treated as two separate babes. They were conjoined at the head sharing some brain tissue with each facing opposite the other- they did not share ears. Maintenance cut a hole in the crib mattress so that when they were turned and the twin on the right was facing down access to the babe's face was from under the mattress. It was quite a challenge when they were intubated but after a while one twin advanced to nasal cannula and the other to nasal CPAP. Try suctioning while you are climbing under a mattress and having to face upward to do that suctioning. With the NCPAP twin having copious secretions it was rather disgusting at times to be underneath him and trying to suction looking upward!It never failed after we turned the NCPAP twin over to face downward he would brady and sometimes recover on his own but sometimes would require needing to be flipped back over to be bagged. It was quite an experience trying to get them flipped quickly enouch to tend to the one crashing! It always required at least two nurses at turning time! After a while we developed a routine and it got a little easier but they were really heavy and awkward.

After months of stretching their scalps by injecting saline into a silastic pouch which had been inserted by a plastic surgeon, they were successfully separated. Although one twin ended up in custodial care as he had the most deficits neurologically, a plate of rib bone formed into a lattice was inserted on the side of his skull to protect his brain. Of course, he had to wear a helmet. The other twin was reported to be completely normal with no developmental delays etc. noted. I had the opportunity to see the more 'successful' twin at age 5 and he seemed completely normal.

Before the twins were separated the OR teams had practice run throughs to make sure everything had been planned correctly for a great outcome. I believe that they had practiced something like 25 or 30 times and in the end the twins ended up being separated emergently because NCPAP twin decompensated and left them with no choice. It was the experience of a lifetime to care for them both before separation and after. Our NICU also received two other sets of conjoined twins during my time there. I didn't take care of either of the other two sets. Both were unsuccessful sparations from the standpoint that only one twin survived during one separation and both twins died from separation of the third set.

Our unit had 22 NiCU beds with two isolation rooms and the Special Care Nursery also had a 22 bed capacity wich could be pushed to 24 in a pinch.

I had to leave my job after getting injured from a lifting injury one day when I was pulled to another unit. I subsequently developed RSD, fibromyalgia, TOS etc. and that ended my beloved career in Neonatal Services. I am unable to work now and am under the care of a pain management physician. Almost all of my time is spent in debilitating neuropathic pain but some days are better than others. I miss my career more than I can say.

Warm personal regards,

PappyRN

pappyRN · Mar 7, 2003

The hospital where I worked was a pediatric tertiary referral center. There is a very active neonatal and pediatric transport team. All babes were transported to our hospital from outlying and local hospitals' nurseries. We received patients from 5 states besides our own. My city also has another pediatric hospital with an active transport team. There are two schools of medicine here, one for each hospital

!

Regards,

PappyRN

dawngloves, BSN, RN · Mar 7, 2003

Pappy, did one or two nurses care for those twins and did you have other babies in your assignment? Sounds like some heavy duty care!And did the twin on the bottom get facial edema from having their face in the "hole"?

NiteNICUNurse, BSN, RN · Mar 8, 2003

Originally posted by nicudaynurse

How big is your unit? Do you transport any babies to other facilities or do you handle them all?

I work in a 45 bed Level 3 NICU with a VERY busy L&D and Maternal Fetal care unit. We also have a busy transport program...the only thing we transport out for is ECHMO but the plan is to start training for that soon.

pappyRN · Mar 9, 2003

Hi Dawngloves,

At first there were two RNs assigned when the twins were still a "novelty" and we were working out all the logistics of turning and positioning and suctioning the NCPAP from underneath without getting slimed! Facial edema was present but was not a significant problem so to speak.

For a while only one nurse was assigned to them when they were stable. We had unit assistants who could help with turning and I was fortunate that we had a lot of cooperation between staff. People would always walk around and offer help if they were finished with their work and then someone would cover for their room while they helped others. I had never had a job where the nurses helped each other out as much as they did at this hospital. We also had assistant head nurses who could help or the discharge planner would help. At feeding time the "office" staff would scrub and come into the unit to help feed so that babes didn't have to wait to eat or get so off schedule. The unit's OT would also be around to help with the difficult feeders.

When it got closer to the time for them to be separated then two nurses were again assigned. This was when the teams were actively role playing to make the day of surgery go smoothly. As they got larger it was of course more awkward to turn them and as their weight increased it became more difficult.

ECMO is done at our hospital and has been for several years. However, babes are moved to the PICU for ECMO for a number of reasons including space- the PICU rooms are much bigger and set up as private rooms as opposed to the open concept of the NICU and SCN. The surgeons preferred the PICU for their ECMO patients and for infection control purposes it worked out better. Also, some of the PICU nurses were also trained as perfusionists. I can't think of where everyone and everything would fit if it was done in the NICU. It was a brand new building and unit with all critical care and emergency services housed in this building. It soon became apparent shortly after it opened that the number of beds was inadequate even at those numbers and even with another full scale pediatric hospital in our city.

I will always be grateful for the wide range of experiences and diagnoses I was able to participate in. My experiences there taught me so much about compassion, empathy and the preservation of dignity. If memory serves me correctly it is the oldest Catholic pediatric hospital in the country if not the ONLY Catholic pediatric hospital. It was an honor to work there and the hospital was widely known for it's charitable works. That's why it has been so difficult in having to give up my career since I developed RSD. Many of the patients were indigent if not almost all of them. I learned many lessons in humility and to appreciate what I had. I also learned to be grateful for whatever I had as it could be taken away before I knew it. It was sad to see so many families devastated by unexpected illnesses and circumstances. As I have seen from my own experiences with my illness, your situation can change in a blink of the eye when you least expect it. It never occurred to me that I would suddenly go from making a very decent amount of money to none just because of a lifting accident at work. It also never dawned on me that I might find myself in a similar situation to the parents and families I met and that I too, would be touched by the compassion of those taking care of me. For so many reasons it is so important NOT to judge people because you may be walking in their shoes some day. I loved that hospital and I miss it terribly. I always felt so proud to have been a part of it. I know we all complain when things get rough and we get tired or when conditions aren't so great but I would give anything to be a nurse again instead of living on disability in pain. I used to eat, breathe, and sleep nursing but now when I let myself think about it too much it makes me terribly sad that I have had to give it up. The hospital has been undergoing renovation and I wish with all my heart that I could be back at work as a nurse and be some small part of it.

Warm personal regards,

PappyRN